Introduction:Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks (“villages”) under the auspices of the [US] Federal Emergency Management Agency (FEMA).Problem:The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde.Methods:The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program (“Operation Assist”) to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented.Results:Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents.Conclusions:There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.

This study investigated the relationship between parental self-efficacy and asthma-related morbidity. Participants included 139 parents of children (ages 5-8) who were diagnosed with asthma and were primarily from lower-income and minority backgrounds. Parents completed a 22-item measure of self-efficacy; factor analysis was conducted on this measure, yielding two factors: learned helplessness and self-efficacy. Correlational analyses indicated that higher scores on the learned helplessness factor were significantly related to increased asthma-related morbidity for the majority of morbidity variables. The self-efficacy factor was significantly related to days of school missed. Regression analyses conducted with the factor scores and the morbidity variables provide further support that the learned helplessness factor accounts for a significant amount of the variance in asthma morbidity for many of the variables studied, while the self-efficacy factor was related to only a few. Although improving health outcomes of children with asthma is a multifaceted process, the results of this study suggest that targeting parental self-efficacy, particularly with parents who are experiencing high levels of perceived learned helplessness, may be a helpful component of an intervention program with this population.

T he term megadisaster has worked its way into the mainstream since the start of the new millennium. The expression once reserved for the technical meaning of the word-a ''one in a million'' disaster-has recently been brought to the forefront by several large natural events that have occurred in the past 5 years, namely Hurricane Katrina in the United States and the Indian Ocean tsunami of 2004. These two disasters, as well as the terrorist attacks of September 2001 in the United States have directed a persistent spotlight on the systems by which the public and its government plan for, respond to, and recover from high-impact catastrophes.From the beginnings of human society, both nature and our own species have found ways to traumatically disrupt the status quo. Despite the many catastrophes in our history, the term disaster has been difficult to define. Most definitions include some reference to the event's impact on people, the economy, or the environment. More theoretically, a disaster can be seen as a complex function of risk and vulnerability. As an example, the magnitude of a hurricane disaster is not as simple as the force of the hurricane itself upon a community but rather a sum of those forces (eg, storm-force winds) plus the special vulnerabilities faced by the community (eg, levee failure) plus the community's capacity to reduce the actual or potential negative consequences of risk (eg, an inability to evacuate citizens). It is complicated interplay among the forces of destruction and the broad ability (or inability) of a community, for myriad reasons, to withstand them and mitigate their impact.There is ranging opinion and there has been much discussion about the practical definition of disaster, much of it dependent upon the context in which the term is being analyzed. Many academics feel that for an incident to be technically classified as a disaster, it must overwhelm the day-to-day routine enough

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ABSTRACT. The American Academy of Pediatrics policy statement "The Pediatrician's Role in Community Pediatrics" encourages all pediatricians to partner with their communities to create and disseminate innovative programs that improve child health. This article describes 4 pillars of a bridge to evidence-based community pediatrics for pediatricians interested in pursuing effective community action: (1) collaborate with the community to establish a specific, short-term, health-related goal; (2) identify evidence-based best practice(s) for achieving the shared goal; (3) collaborate with the community to adapt this best practice to the community's unique assets and constraints; and (4) evaluate the project by using appropriate expertise. Practical elements of each pillar are described and illustrated by specific examples from community-based efforts of pediatricians and are accompanied by specific resources to aid pediatricians in their future community health work. Pediatrics 2005;115: 1142-1147; community-based participatory research, community pediatrics, evidence-based medicine.